Provider Demographics
NPI:1093384216
Name:MULFORD, KATY LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:LYNN
Last Name:MULFORD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:LYNN
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 RODNEY CT
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-8512
Mailing Address - Country:US
Mailing Address - Phone:909-735-1887
Mailing Address - Fax:
Practice Address - Street 1:125 EDINBURGH SOUTH DR STE 106
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6484
Practice Address - Country:US
Practice Address - Phone:919-785-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7476225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant